WEBVTT
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Hi this is Dave deBronkart!
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I’m not known on the
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internet as “E-Patient Dave”.
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The E stands for
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empowered,
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engaged,
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equipped,
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enabled and I’m the chair
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emeritus and one of the
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co-founders of the society
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for participatory medicine
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whose logo you can see
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on the screen here.
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In 2007, nearly 10 years ago,
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I discovered I was almost
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dead from stage 4 kidney
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cancer and based on
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advice from my doctor,
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Doctor Danny Sands who
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is the co-author of the
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book you can see here,
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“Let Patients Help.”
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He’s a pioneer of the
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E-Patient movement back
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in the 1990s and I got
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information from the
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internet that today my
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oncologist says help
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save my life.
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And so we are among the
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leaders of the E-Patient
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movement worldwide.
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And I want to talk to you
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here today about the
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subject of Geriatrics
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because truly compared
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to when I was a child,
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when I was growing up,
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Geriatrics, the care of
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elder people, is not what
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it used to be.
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Being 65, I’m 66 years old
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myself as I speak this,
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is no longer the “feebled,
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declining age that we
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thought it was and
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it changes.
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What we need to do as
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we approach either our
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own aging or caring for
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other elders.
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Fortunately, the internet
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helps us be aware of
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what our options are.
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You can find me on the
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internet by the name
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“E-Patient Dave,” just
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search anywhere and
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you’ll find me.
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I’d be happy to connect.
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Just do me a favor and
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say how you found me.
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Now, I presented this talk
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originally at the nursing
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informatics conference in
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Geneva switzerland and it
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pointed out that Simone
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de Beauvior had
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published the world
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changing book
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“The Coming of Age”
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but in fact its French title,
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I can’t pronounce it very
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well, but it was
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“La Vieillesse,” which
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just means “Old Age”.
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And...she was...she
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seemed very fatalistic
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about it.
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Now this was almost a
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half century ago,
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hopeless about aging.
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Here’s what she wrote in
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this book.
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“It’s far better not to think
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about it too much but to
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live a fairly committed,
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fairly justified life so that
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one may go on in the
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same path even when all
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illusions have vanished
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and one’s zeal for life has
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died away.”
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Basically live your life
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and be happy with it,
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so that even when you’re
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out of time,
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you’ll be content.
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Well, a lot has changed in
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the 46 years since she
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said that.
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A lot has changed in
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what’s possible.
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Health care has
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improved, a lot
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has improved.
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In fact, today technology
00:03:14.760 --> 00:03:16.080
can even change your
00:03:16.080 --> 00:03:17.080
philosophy as
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you’ll be seeing.
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First of all,
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if you live long enough,
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and I’ve experienced this.
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If you’ve lived
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long enough,
00:03:25.660 --> 00:03:26.900
the future changes.
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Here’s an example.
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This was my friend
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Jay Parkinson,
00:03:31.960 --> 00:03:34.920
who I went to college with
00:03:34.920 --> 00:03:36.050
and here he is at a
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baseball game in
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philadelphia with
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his daughter.
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Men in his family have
00:03:42.230 --> 00:03:44.319
never lived as long as
00:03:44.319 --> 00:03:45.630
he’s lived.
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When he sent me
00:03:46.630 --> 00:03:47.920
this photo,
00:03:47.920 --> 00:03:48.920
he said that he was
00:03:48.920 --> 00:03:50.300
having a pacemaker put
00:03:50.300 --> 00:03:51.680
in his heart and the
00:03:51.680 --> 00:03:53.940
reason he was alive to
00:03:53.940 --> 00:03:55.459
have a pacemaker put in,
00:03:55.459 --> 00:03:57.080
is because twice in the
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past 10 years,
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medicine saved him
00:04:00.299 --> 00:04:01.810
from dying.
00:04:01.810 --> 00:04:02.810
The way men used to
00:04:02.810 --> 00:04:04.870
always die and this is
00:04:04.870 --> 00:04:06.849
happening to lots of people,
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men in his family
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particularly.
00:04:08.950 --> 00:04:09.950
This is happening to
00:04:09.950 --> 00:04:10.950
lots of people.
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I almost died when I was
00:04:12.459 --> 00:04:14.280
56 years old from
00:04:14.280 --> 00:04:15.750
kidney cancer,
00:04:15.750 --> 00:04:17.030
but I survived and here
00:04:17.030 --> 00:04:19.410
I am giving this talk today.
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Here is the future.
00:04:22.550 --> 00:04:23.550
When Jay and I
00:04:23.550 --> 00:04:24.550
were born,
00:04:24.550 --> 00:04:27.349
we were both born in 1950.
00:04:27.349 --> 00:04:28.650
This is a graphic from the
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pew research project
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from their book
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“Next America,”
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and it applies all around
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the world.
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When we were born
00:04:37.770 --> 00:04:39.199
in 1950,
00:04:39.199 --> 00:04:41.389
this is the shape of the
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population data.
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Every stripe is 5 years of age.
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The brown lines the dark
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brown lines represent
00:04:50.819 --> 00:04:52.289
baby boomers at the end
00:04:52.289 --> 00:04:54.331
of World War 2 and you
00:04:54.331 --> 00:04:55.689
can see that in those
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days with every growing
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five years after you were
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40 years old or even
00:05:00.740 --> 00:05:02.620
35 years old.
00:05:02.960 --> 00:05:04.180
More and more people
00:05:04.180 --> 00:05:05.180
were dying and the
00:05:05.180 --> 00:05:06.180
population was
00:05:06.180 --> 00:05:07.479
getting smaller.
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Only a small part of the
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population was 65 years
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and older.
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Well now when they
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published this in 2015,
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here’s what that
00:05:18.419 --> 00:05:19.849
looked like.
00:05:19.849 --> 00:05:21.270
And people say the
00:05:21.270 --> 00:05:22.979
population pyramid is
00:05:22.979 --> 00:05:23.539
becoming a
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population rectangle.
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And you can see the
00:05:26.759 --> 00:05:27.800
baby boomers,
00:05:27.800 --> 00:05:30.210
most of us are still alive,
00:05:30.210 --> 00:05:34.009
and 34 years from now,
00:05:34.009 --> 00:05:37.460
when I turn 100 years old,
00:05:37.460 --> 00:05:38.460
you can see that in
00:05:38.460 --> 00:05:40.050
addition to the population
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getting wider,
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it has gotten much older
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as well.
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Truly unprecedented
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population profile.
00:05:50.740 --> 00:05:51.520
And if you look at the
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top bar there,
00:05:53.000 --> 00:05:55.369
it shows that 5% of the
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population will be
00:05:56.969 --> 00:05:59.659
85 years old.
00:05:59.659 --> 00:06:01.749
Now, that means the
00:06:01.749 --> 00:06:03.399
future is not so hopeless
00:06:03.399 --> 00:06:07.539
when you’re 60,70, and 80 years old.
00:06:07.980 --> 00:06:09.719
Technology will help.
00:06:09.719 --> 00:06:11.719
Here’s a blog post that
00:06:11.719 --> 00:06:14.319
I found in 2013,
00:06:14.320 --> 00:06:16.020
more than 3 years ago
00:06:16.029 --> 00:06:17.659
and the surgeon saw the
00:06:17.659 --> 00:06:20.499
statistics saying that two
00:06:20.499 --> 00:06:22.520
thirds of all people who
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have ever been age 65 in
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the world are alive today.
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Now I just wrote it as half
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of everyone who’s ever
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been alive today,
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but that’s a...nobody’s
00:06:36.599 --> 00:06:38.159
ever lived in a world with
00:06:38.159 --> 00:06:39.460
this future.
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You and I are living a
00:06:41.479 --> 00:06:42.879
condition of humanity that
00:06:42.879 --> 00:06:45.069
has never existed and we
00:06:45.069 --> 00:06:46.979
have evidence for this.
00:06:46.979 --> 00:06:48.009
So the question,
00:06:48.009 --> 00:06:49.059
if you’re learning,
00:06:49.059 --> 00:06:50.110
thinking about the future
00:06:50.110 --> 00:06:52.649
is are you ready for this
00:06:52.649 --> 00:06:54.389
new world?
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New resources are
00:06:55.389 --> 00:06:56.559
becoming available.
00:06:56.559 --> 00:06:57.639
This is an excellent
00:06:57.639 --> 00:06:59.929
podcast that just started
00:06:59.929 --> 00:07:01.249
in the past year from a
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friend of mine,
00:07:02.479 --> 00:07:04.319
Dr. Lesley Kernisan,
00:07:04.319 --> 00:07:06.280
“better health while aging.”
00:07:06.280 --> 00:07:08.009
It’s available anywhere
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that there’s an
00:07:09.009 --> 00:07:10.759
internet connection.
00:07:10.759 --> 00:07:11.789
And what I like about
00:07:11.789 --> 00:07:14.139
Dr. Kernisan is that she
00:07:14.139 --> 00:07:15.520
makes all the most
00:07:15.520 --> 00:07:17.539
complicated subjects
00:07:17.539 --> 00:07:19.621
clear and simple it’s just
00:07:19.621 --> 00:07:21.759
the kind of doctor she is.
00:07:21.759 --> 00:07:23.449
She is a geriatrician herself.
00:07:23.449 --> 00:07:26.699
It even starts with the definition.
00:07:26.699 --> 00:07:27.699
She says,
00:07:27.699 --> 00:07:28.930
“In every podcast,
00:07:28.930 --> 00:07:30.879
Geriatrics is the art and
00:07:30.879 --> 00:07:32.270
science of modifying
00:07:32.270 --> 00:07:33.800
medicine so that it worked
00:07:33.800 --> 00:07:35.919
better for older people
00:07:35.919 --> 00:07:38.490
and their families.
00:07:38.490 --> 00:07:39.490
So have a look,
00:07:39.490 --> 00:07:41.009
I’ve seen several of
00:07:41.009 --> 00:07:42.009
those podcasts.
00:07:42.009 --> 00:07:43.679
I’m not that old myself but
00:07:43.679 --> 00:07:44.759
I’ve already seen several
00:07:44.759 --> 00:07:45.759
that have changed how I
00:07:45.759 --> 00:07:46.759
think about
00:07:46.759 --> 00:07:48.029
my own health.
00:07:48.029 --> 00:07:49.909
So here is a good question.
00:07:49.909 --> 00:07:52.169
How can we empower
00:07:52.169 --> 00:07:53.699
patients and families to
00:07:53.699 --> 00:07:56.169
improve their health and care?
00:07:56.169 --> 00:07:57.169
Of any age?
00:07:57.169 --> 00:07:59.349
Well, there is a definition
00:07:59.349 --> 00:08:00.539
of empowerment that’s
00:08:00.539 --> 00:08:02.079
very useful here.
00:08:02.340 --> 00:08:05.219
Increasing the capacity of
00:08:05.219 --> 00:08:06.919
individuals or groups to
00:08:08.400 --> 00:08:10.599
make choices about what
00:08:10.599 --> 00:08:12.279
they want.
00:08:12.279 --> 00:08:13.279
Those are my words
00:08:13.279 --> 00:08:14.819
added, not their’s.
00:08:14.819 --> 00:08:15.860
And then to transform
00:08:15.860 --> 00:08:17.779
those choices into actions
00:08:17.779 --> 00:08:19.529
and outcomes.
00:08:19.529 --> 00:08:21.310
You can see looking at this,
00:08:21.310 --> 00:08:22.339
this takes the general
00:08:22.339 --> 00:08:24.360
concept of empowerment
00:08:24.360 --> 00:08:25.360
and makes it something
00:08:25.360 --> 00:08:26.360
where we can use in
00:08:26.360 --> 00:08:27.530
engineering approach,
00:08:27.530 --> 00:08:29.379
really if we want to.
00:08:29.379 --> 00:08:30.479
So we want to increase
00:08:30.479 --> 00:08:32.219
people’s capacity so
00:08:32.219 --> 00:08:33.279
anything we do that
00:08:33.279 --> 00:08:34.909
increases capacity will
00:08:34.909 --> 00:08:36.789
be empowering,
00:08:36.789 --> 00:08:38.289
specifically the capacity to
00:08:38.289 --> 00:08:39.289
make choices,
00:08:39.289 --> 00:08:40.349
to think about well what
00:08:40.349 --> 00:08:41.349
do I want?
00:08:41.349 --> 00:08:43.039
What’s important to me?
00:08:43.039 --> 00:08:44.039
When we help people
00:08:44.039 --> 00:08:45.039
think about that
00:08:45.039 --> 00:08:46.039
it’s empowering.
00:08:46.039 --> 00:08:47.039
And then once they
00:08:47.039 --> 00:08:48.330
thought about that,
00:08:48.330 --> 00:08:49.710
anything we do that helps
00:08:49.710 --> 00:08:52.279
them take action will
00:08:52.279 --> 00:08:53.900
be empowering.
00:08:53.900 --> 00:08:54.930
And anything that blocks
00:08:54.930 --> 00:08:56.220
them from taking action
00:08:56.220 --> 00:08:58.589
will be disempowering.
00:08:58.589 --> 00:08:59.589
So now we take the
00:08:59.589 --> 00:09:00.610
whole idea of
00:09:00.610 --> 00:09:01.610
empowerment,
00:09:01.610 --> 00:09:03.399
which is kind of vague,
00:09:03.399 --> 00:09:04.589
and turn it into something
00:09:04.589 --> 00:09:07.110
that is ready for solutions.
00:09:07.110 --> 00:09:09.019
My doctor, Dr. Sands,
00:09:09.019 --> 00:09:10.720
co-author of my book,
00:09:10.720 --> 00:09:12.760
expresses it this way,
00:09:12.760 --> 00:09:15.230
“knowledge is power.
00:09:15.230 --> 00:09:17.180
When you know more you
00:09:17.180 --> 00:09:19.070
are more able to
00:09:19.070 --> 00:09:20.230
take powerful,
00:09:20.230 --> 00:09:21.880
effective, action.
00:09:21.940 --> 00:09:23.399
This famous quote from
00:09:23.399 --> 00:09:25.350
Sir Francis Bacon.
00:09:25.350 --> 00:09:26.779
So, Information
00:09:26.779 --> 00:09:28.709
is empowering.
00:09:28.709 --> 00:09:29.910
We can also see that to
00:09:29.910 --> 00:09:32.139
withhold information
00:09:32.139 --> 00:09:34.649
is disempowering.
00:09:34.649 --> 00:09:35.730
So now we can look at it
00:09:35.730 --> 00:09:37.089
as what do we do to get
00:09:37.089 --> 00:09:38.089
our hands on
00:09:38.089 --> 00:09:39.290
useful information.